首诊慢阻肺错失早期诊断时间与疾病严重程度相关  

Delayed diagnosis is associated with greater disease severity of chronic obstructive pulmonary disease

作　　者：彭显如 黄敏於 赵文驱 袁亚飞 李博厚 叶艳梅[1] 粱健鹏 朱顺芳[1] 刘来昱[1] 蔡绍曦[1] 赵海金[1] PENG Xianru;HUANG Minyu;ZHAO Wenqu;YUAN Yafei;LI Bohou;YE Yanmei;LIANG Jianpeng;ZHU Shunfang;LIU Laiyu;CAIShaoxi;ZHAO Haijin(Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern MedicalUniversity, Guangzhou 510515, China)

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科,慢性气道疾病实验室,广东广州510515

出　　处：《南方医科大学学报》2018年第12期1448-1452,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81770033,81470228,81670026,81700034);广东省自然科学基金(2015A030313236);广东省科技计划项目(2016A020215117,2017B020226006);广州市科技计划项目(201804010069);国家重点研发计划(2016YFC0905800).

摘　　要：目的调查南方医院就诊的慢性阻塞性肺疾病(慢阻肺)患者从出现症状至确诊的时间(错失早期诊断时间),探讨其与疾病严重程度的关系。方法筛选我院2015年5月～2018年2月临床首次确诊慢阻肺患者,慢阻肺和哮喘慢阻肺重叠(ACO)诊断基于GOLD指南和欧洲标准,按照GLOD指南进行肺功能分级。结果入组慢阻肺患者803例,平均年龄61.8±9.9岁,男性726例,女性77例,入组对象平均错失早期诊断时间为3(0.5,8)年;根据GOLD标准,诊断为慢阻肺中度及以上占比85.2%,重度及以上占比为48.3%,其中47.0%为支气管舒张试验阳性,进一步诊断ACO为295例,占36.7%。ACO错失早期诊断时间为3(1,9)年,相比慢阻肺3(0.5,8)年,两者无显著差异(P>0.05);所有入组对象错失早期诊断时间与肺功能显著相关(P<0.05);多元线性回归分析显示:年龄、错失早期诊断时间与疾病严重程度相关。结论首诊慢阻肺错失早期诊断时间与疾病严重程度密切相关,临床需加强早期识别。Objective To investigate the association of the time of initial diagnosis with the severity of chronic obstructive pulmonary disease (COPD). Methods A total of 803 patients who were diagnosed to have COPD for the first time in our hospital between May 2015 to February 2018 were enrolled in this study. The diagnoses of COPD and asthma COPD overlap (ACO) were made according GOLD guidelines and european consensus definition. Lung function of the patients was graded according to the GOLD guidelines. Results The patients with COPD had a mean age of 61.8±9.9 years, including 726 male and 77 female patients. The course of the patients (defined as the time from symptom onset to the establishment of a diagnosis) was 3(0.5, 8)years. Among these patients, 85.2% had a moderate disease severity (FEV1%<80%), and 48.3% had severe or very severe conditions (FEV1%<50%); 47.0% of them were positive for bronchial dilation test. In the overall patients, 295 (36.7%) were also diagnosed to have ACO, and the mean disease course of ACO [3 (1, 9) years] was similar to that of COPD [3 (0.5, 8) years](P>0.05). A significant correlation was found between the disease course and the lung function of the patients. Multiple linear regression analysis showed that an older age and a longer disease course were associated with poorer lung functions and a greater disease severity. Conclusion The delay of the initial diagnosis is significantly related to the severity of COPD.

关 键 词：慢阻肺 错失早期诊断时间 严重程度 慢阻肺和哮喘慢阻肺重叠 

分 类 号：R563.9[医药卫生—呼吸系统]